DIETS, NUTRITION AND LIVING LONGER Charlene LePane DO, MSPH FASGE FACG FACOI Site Director AdventHealth GI Fellowship Asst Professor Internal Medicine NSUCOM, KCUMB, LECOM AdventHealth Medical Group TOPICS TO DISCUSS • Nutrients: – (macro=carbohydrates, protein and fat) – (micro=vitamins and minerals) • Elements • Diets: keto, vegan, gluten-free, paleo • How to live longer VITAMIN A BENEFITS • Keeps tissues and skin healthy (tretinoin topical Retin-A reduce appearance of fine wrinkles and treat acne) • Plays an important role in bone growth and in the immune system • Diets rich seems to lower lung and prostate cancer risk • Carotenoids act as antioxidants • Foods rich may protect against cataracts • Retinoids and Carotene • Includes retinol, retinal, retinyl esters, and retinoic acid referred to as “preformed” vitamin A (lipid soluble vitamin found in animal fat sources) • Beta carotene (vegetable sources) can easily be converted to vitamin A as needed VITAMIN A RDA • 900 mcg (3,000 IU) (upper limit 3000mcg or 10,000 IU) • Sources of retinoids: – beef liver, eggs, shrimp, fish, fortified milk, butter, cheddar cheese, Swiss cheese • Sources of beta carotene: – sweet potatoes, carrots, pumpkins, squash, spinach, mangoes, turnip greens VITAMIN A DEFICIENCY * • It is the world's leading cause of preventable blindness in children • Increases the risk of disease and death • In pregnant women night blindness and increase risk of maternal mortality THIAMINE (VITAMIN B1) • Needed for healthy skin, hair, muscles, and brain and nerve function • M 1.2 mg, W 1.1 mg • Pork chops, brown rice, ham, soymilk, watermelons, acorn squash THIAMINE (VITAMIN B1) : • Thiamin (vitamin B1) convert carbohydrates into energy (nervous system) • Helps muscle contraction and conduction of nerve signals • Deficiency called beriberi and can cause weakness, fatigue, psychosis and nerve damage • Alcoholics are at high risk THIAMINE (VITAMIN B1) • Fatigue and anorexia • Indigestion or constipation d/t improper muscle tone in the GI tract • Muscle tenderness • Numbness in the arms and legs d/t improper nerve function • Beriberi-a chronic neurological and cardiovascular disease • Wenicke-Korsakoff syndrome-causes brain abnormalities, opthalmoplegia RIBOFLAVIN (VIT B2) SOURCES • M 1.3 mg, W 1.1 mg • Helps convert food into energy • Needed for healthy skin, hair, blood, and brain • Milk, Eggs, Yogurt, Cheese, Meats • Green leafy vegetables • Whole and enriched grains and cereals RIBOFLAVIN (VIT B2) DEFICIENCY • cheilosis (lesions on the lips) • angular stomatitis (cheleitis) (lesions on the angles of the mouth typically caused by yeast) • glossitis (fissured and magenta-colored tongue) • corneal vascularization • dyssebacia (red, scaly, greasy patches on the nose, eyelids, scrotum, and labia) • normocytic, normochromic anemia NIACIN (VIT B3) * • Helps convert food into energy • Essential for healthy skin, blood cells, brain, and nervous system • Lowers LDL ,increase HDL and lower triglycerides • Taking too much niacin causes flushing, (especially with ETOH) – Aspirin reduces this flushing • M: 16 mg, W: 14 mg • Meat, Poultry, Fish, fortified and whole grains, Mushrooms, Potatoes, Peanut butter NIACIN (VIT B3) DEFICIENCY • PELLAGRA • Dermatitis • Dementia • Diarrhea • Death PANTOTHENIC ACID (VIT B5) • Helps convert food into energy • M: 5 mg, W: 5 mg • Helps make: – Lipids • Chicken – Neurotransmitters • egg yolk – steroid hormones – hemoglobin • whole grains • Helps create CoA along with • Broccoli cysteine, adenosine and triphosphate • Mushrooms – CoA involved in synthesis and • Avocados oxidation of FA and oxidation of pyruvate in Krebs cycle • tomato products PANTOTHENIC ACID (VIT B5) DEFICIENCY • Burning feet • Fatigue • Headaches • Tingling in hands and feet • Nausea • Irritability • Insomnia PYRIDOXINE (VIT B6) • Aids in lowering homocysteine is a non-proteinogenic α- amino acid and is biosynthesized from methionine (essential AA) by the removal of its terminal methyl group • May reduce the risk of heart disease (high levels of homocysteine associated with heart disease) • Studies show an extra dose B6 helps relieve morning sickness • Helps convert tryptophan to serotonin neurotransmitter that plays key roles in sleep, appetite, and moods PYRIDOXINE (VIT B6) • Helps make norepinephrine • Studies show individuals with a deficiency in Vit B6 are 3.5 • Influences cognitive times more likely to have a abilities and immune cognitive decline in function adulthood • Allows the body to use and • Skin inflammation, scaly store energy from protein and dermatitis, anemia, carbohydrates to form depression, dizziness, nausea hemoglobin and sores in mouth • Without this vitamin the • COMMON DEFICIENCY thyroid cannot utilize its iodine raw material efficiently to make the hormones PYRIDOXINE (VIT B6) • Long term high doses of • Meat vitamin B6 can be toxic and may result in nerve • Fish damage loosing control • Poultry of body movements • Legumes • 31–50 years old: M: 1.3 mg, W: 1.3 mg • Tofu and soy products • 51+ years old: M: 1.7 mg, W: • Potatoes 1.5 mg • Non-citrus fruits such as bananas and watermelons COBALAMIN (VIT B12) • Aids in lowering homocysteine levels and may lower the risk of heart disease • Assists in making new cells and break down fatty acids and amino acids • Protects nerve cells and encourages growth • Helps make RBCs and DNA • M: 2.4 mcg, W: 2.4 mcg • Meat, Poultry, Fish, Milk, Cheese, Eggs, Fortified cereals, Fortified soymilk CAUSES OF B12 DEFICIENCY • Pernicious anemia(parietal • Atrophic gastritis cells IF and acid) • Chronic H pylori infection • Dietary deficiency (vegan) • Chronic antacid use>12 mo • Malabsorption • Chronic alcoholism – Crohns disease (malnutrition) – Chronic pancreatitis • Use of metformin >4 mo – Whipple’s disease (interferes with Ca- – Parasite dependent membrane for B12-IF absorption) • Post surgical malabsorption – Gastrectomy – Terminal ileum resection COBALAMIN (VIT B12) DEFICIENCY * • Pernicious anemia is the most common cause of B12 deficiency: – Autoimmune; attack against parietal cells (IF) – extreme lack of energy – pins and needles (paresthesia) – sore and red tongue – muscle weakness – depression – problems with memory, understanding, and judgement BIOTIN (VITAMIN B7) • Helps convert food into energy and synthesize glucose • Helps make and break down some fatty acids • Needed for healthy bones and hair • Biotin is essential for the metabolism of fat and only a tiny amount is required • Some is made by bacteria in the GI tract • Not clear how much of this the body absorbs • M: 30 mcg, W: 30 mcg • Whole grains, Organic meats, Egg yolks, Soybeans, Fish BIOTIN • Taking a biotin supplement could cause falsely elevated or suppressed thyroid levels – avoid taking any biotin supplements at least a day or two before blood test to ensure accurate results • May be a helpful adjunct in the treatment of multiple sclerosis (MS) by improving myelin repair and facilitating cellular energy production • Biotin plays a role in energy production • Commonly used to remediate neurological problems, alopecia and skin conditions (acne, eczema) BIOTIN DEFICIENCY • Alopecia • Conjunctivitis • Dermatitis with scaly, red rash around the eyes, nose, mouth, genitals • Neurological symptoms such as depression, lethargy, hallucination and paresthesia ASCORBIC ACID (VIT C) • Foods rich in vitamin C may lower the risk for some cancers, including those of the mouth, esophagus, stomach, and breast • Long-term use of supplemental vitamin C may protect against cataracts • Helps make collagen; connective tissue that binds wounds and supports blood vessel walls • Helps make the neurotransmitters serotonin and norepinephrine • Acts as an antioxidant, neutralizing unstable molecules that can damage cells • Bolsters the immune system • M: 90 mg, W: 75 mg Smokers: Add 35 mg (to counteract the damage that smoking causes to cells) ASCORBIC ACID (VIT C) DEFICIENCY • Deficiency disease is called scurvy • Evidence that vitamin C helps with colds not convincing • Deficiency symptoms: • fruits and fruit juices (especially – Anemia citrus) – Atherosclerotic plaques and • potatoes pinpoint hemorrhages • broccoli – Bone fragility and joint pain • bell peppers – Poor wound healing and frequent infections • Spinach – Bleeding gums and loosened teeth • Strawberries – Muscle degeneration and pain, • Tomatoes hysteria and depression • brussels sprouts – Rough skin and blotchy bruises CALCIFEROL (VIT D) • Helps maintain normal blood levels of calcium and phosphorus, which strengthen bones – Calcium cannot be absorbed without vitamin D • Helps form teeth and bones • Supplements can reduce the number of non-spinal fractures • Some reports suggest as much as 42% of the US population has a Vitamin D deficiency • Fortified milk, margarine, fortified cereals, fatty fish CALCIFEROL (VIT D) DEFICIENCY • Rickets in children – Imperfect calcification, softening and distortion of the bonesbowed legs • Weakness, aches, and pains in adults where bones don't have enough calcium, called osteomalacia in adults ALPHA-TOCOPHEROL (VIT E) • Acts as an antioxidant, neutralizing unstable molecules that can damage cells • Protects Vitamin A and certain lipids from damage • Does not prevent wrinkles or slow aging processes • Deficiency unlikely; stored in body • Helps maintain healthy skin and eyes, while also strengthening the immune system • Current research finding vitamin E may help slow the growth of dementia, particularly Alzheimers • Studies demonstrate Vit E decreases risk for prostate,